Life, Liberty, and the Pursuit of Happiness are Not Size Dependent

The FDA has approved a device called the AspireAssist, in which a thin tube is placed in the patient’s stomach that connects to a button on the outside of their stomach. After each meal the patient uses the tube and a handheld device to pump up to 30% of the meal out of their stomach and into the toilet. I’m going to address the claims on their website, but first I want to talk about a misconception

[Trigger Warning – Eating Disorder talk for the next two paragraphs] The company that makes it claims that it isn’t an “assisted bulimia” device because they say in their fine print that it shouldn’t be used by people with bulimia. That is, of course, ridiculous and it’s certainly possible that this device my be used by people dealing with bulimia and/or my perpetuate the development of bulimia. But it should be clear this isn’t actually medically induced bulimia. Bulimia, like all eating disorders, is a complex bio/psych/social illness. Purging is one of the behaviors associated with Bulimia as well as other eating disorders, but it shouldn’t be confused with the illness itself and purging in this way, rather than through the use of vomiting, creates different possible issues/side effects.

My concern here is that this is another example of prescribing to fat people what we diagnose in thin people. If someone says that they are evacuating food after every meal we shouldn’t treat it like a red flag for thin people, but a good idea for fat people – it should be considered a red flag behavior for someone of any size. Eating disorders are often confused for simply behaviors, or people become more “fascinated” with the behaviors/symptoms than they are compassionate to the person with the ED, so I think it’s important not to reinforce those misconceptions and issues because it leads to difficulties for people with EDs being taken seriously, getting treatment, and getting that treatment paid for.

I also want to be clear that I’m not against the people who individually choose to use it – their body, their choice. I’m against the fact that a for-profit company is misleading people about what this device can do, and will be making money off the backs of anti-fat panic, not concerned with the fact that one of the side effects of their contraption is death.

Now, let’s talk about what the company who created these devices says, and what is actually true:

The AspireAssist has been studied in hundreds of patients in both the US and in Europe. In a large U.S. clinical trial with 171 participants, people using the AspireAssist lost 3 times as much weight as people who received only lifestyle counseling. The most successful patients – those who aspirate regularly and learn to make healthier choices – have lost 100% of their excess weight with the AspireAssist and have maintained that weight loss for more than four years so far. Compared to other approaches, the AspireAssist has similar results without requiring invasive alterations to the anatomy or digestive process

Here they use two of the most common tricks weight loss companies use to mislead us about outcomes. The first is to only study patients for a short time (from a few months to a couple of years) but define that as “long term” when, in fact, most people are able to temporarily change their weight during a year, and then they gain the weight back between years 2 and 5, often regaining more than they lost. That US Clinical trial they talk about only studied the first year.

The second trick is to only include those who completed the trial so there is no follow up with those who dropped out (and possibly didn’t lose weight, or began to regain, or had side affects so horrible that they didn’t think any outcome was worth it.) They cite a two year study that included 80 people in the first year, but was down to 25 people at year two, that means that almost 70% of the group dropped out, but they want us to be convinced by the average of what happened with 31.25% of the participants and ignore what happened to 68.15%. As to their claim of people who have lost 100% of their “excess weight” and maintained it for four years, I can find absolutely no research anywhere on their site or anywhere else to back up that claim. I left to wonder if they are holding up a couple anomalies as the norm, or just completely making stuff up.

The AspireAssist allows patients to remove about 30% of the food from the stomach before the calories are absorbed into the body, causing weight loss. You’ll also need to chew carefully and eat mindfully, which helps give time for the fullness signals from your stomach to reach your brain.

Because aspiration only removes a third of the food, the body still receives the calories it needs to function.

First let’s realize that they are just assuming that fat people don’t need the nutrition from 30% of what we eat, regardless of what we eat, how much, our physical activity level etc. Well, either that or they just think it’s fine for us to be malnourished as long as we’re becoming thinner. Second, when they say you need to “chew carefully” it’s because the tube is only 6mm and larger chunks of food can get stuck in the tube which, if the patient can’t clear it with water, requires another trip to the doctor.

In addition to the machine, people also get “lifestyle counseling”

This therapy is used in conjunction with lifestyle counseling. This program combines one-on-one counseling and group support meetings to encourage healthier food choices, smaller portion sizes, and increased physical activity.

There is not a single study that suggests that this type of counseling leads to long term weight loss or better health, but that doesn’t matter since they can just blame the fat people when it doesn’t work. In the US a panel that recommended this type of therapy also acknowledged that “One problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.” and yet the Federal Task Force still recommended it.(One wonders, if one of the problems is that there is no reason to believe this will work, does it really matter what the other problems are?) But none of that is getting in the way of Aspire charging $8,000 to $13,000 for it according to Aspire spokeswoman Christy Kaupinen.

Consider your schedule at work, at home, on weekends, and with your family or friends. Although missing an aspiration occasionally is OK, the most successful patients aspirate three times per day, almost every day.

You have to wait 20-30 minutes after each meal, and it then takes 5-10 minutes to drain the food into the toilet (after people gain competency, it takes longer in the beginning,) which they recommend patients do three times a day. That’s 7.5 to 15 HOURS A MONTH that a patient will spend in the bathroom. I don’t know about you, but I haven’t been sitting around thinking “Man, I have 7.5-15 hours a month that I would love to spend in the restroom.” Plus there’s the time and expense of having to go back to the doctor every 5-6 weeks because the device is created to stop working until you replace a part that is designed to wear out for this purpose.

Side effects related to use of the AspireAssist include occasional indigestion, nausea, vomiting, constipation and diarrhea.

The endoscopic surgical placement of the gastric tube is associated with risks, including sore throat, pain, abdominal bloating, indigestion, bleeding, infection, nausea, vomiting, sedation-related breathing problems, inflammation of the lining of the abdomen, sores on the inside of the stomach, pneumonia, unintended puncture of the stomach or intestinal wall and death.

Risks related to the abdominal opening for the port valve include abdominal discomfort or pain, irritation, hardening or inflammation of the skin around the site where the tube is placed, leakage, bleeding and/or infection around the site where the tube is placed and device migration into the stomach wall. All have the potential to necessitate removal of the device. After device removal, there may be a risk of persistent fistula, an abnormal passageway between the stomach and the abdominal wall.

…and death. …and death. …and death. Once again it seems that in the “War on Obesity” they want us thin or they want us dead and they don’t seem to much care which it is, as long as they can make a tidy profit along the way. And since the approval came on the basis of a study that only included 111 people using the device and 60 in a control group, who knows what side effects we’ll find if, heaven forbid, this thing gets into wide use.

It doesn’t have to be this way. We can stop buying into the idea that”thin by any means necessary” is the same thing as healthy. We could refuse to participate in so-called “health interventions” that are extremely profitable for others, and potentially deadly for us. We could insist that the discussion be about actual health – with all of its facets and complications – instead of about risking our actual health and even our lives in an attempt to manipulate our body size. We could say enough if enough and that, as long as they want a “war on obesity” we will give them one.

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Reblogged this on I think you'll find I can and commented:
Well, this is what I get for thinking ‘poo pills?? That’s the worst thing they could possibly do to us’.

“…and death. Once again it seems that in the “War on Obesity” they want us thin or they want us dead and they don’t seem to much care which it is, as long as they can make a tidy profit along the way.”

It’s hard to single out any one “most messed-up” aspect of this sugically-assisted purge device, but that’s definitely up there. “You need a routine back surgery to stay mobile and active? Sorry, you’re too fat. It’s too *dangerous.* Instead, how about we reroute your small intestine, implant an esophageal stint, stitch metal into your tongue, and dig a hole in you to implant an auto stomach-pump? If you lose weight and don’t die from those procedures, maybe, just *maybe,* it will be safe enough to make the tiny non-invasive incision that will cure your back pain.”

Yeah, I just LOVE how it’s so impossible to do surgery on fat people, unless that surgery has the very teeny-tiny, eensy-weensy possibility of making them thin (with HORRIBLE side effects). Then, it’s “perfectly safe.”

I wonder if there’s some wonderful doctor out there who’s willing to offer a second opinion in a form letter:

[Procedure to cure anything from congenital malformation of the skull to toenail fungus] is indicated for [fat person being denied treatment for anything from congenital malformation of the skull to toenail fungus becuz faaaaaat] because XYZ BS study suggests a 0.00000001% chance that it will make them thin thinnety thin thin thinnnnnn!

Yes, yes and yesssssss to all your comments. NO SURGERY FOR YOU, YOU ARE TOO FAT!!!! I was a shut in for 10 yrs because I was too fat to get a knee replacement! I was turned down by the only orthopedic group in Greenville, NC 3 times! They told me to have the Greenville Gastric Bypass and lose at least 100lbs first! Finally I was told about Dr. Greenlaw in New Bern, NC-a great surgeon who told me he operated on young, old, those with heart problems, lung problems, obese and diabetic, etc. I thank GOD we were referred to him! I got my new knee in Aug 2014 & started my life again, without a gastric bypass. There is hope you guys!

WTF is the FDA thinking in approving this torture device? There will always be some jerkwad to figure out a new way to make money off the abuse of fat folks, but the FDA is supposed to be the sanity checkpoint. Not so much. FDA is useless.

They should earn an award for their amazing double talk skillz. Purging is bulimia, except when you’re using our product, in which case it’s not bulimia, it’s healthy, even though this device could cause you to have nausea, vomiting, diarrhea, or death.

… and horrible infections, and internal bleeding, and permanent holes in your stomach and/or the surrounding tissue, and parts might break off and migrate… I googled this device, and the only thing more horrifying than what it does is how many clueless fatphobic pundits are trembling with excitement at the prospect of it doing those things *to us.*

Reblogged this on and commented:
Um no thank you! Okay people I’m going to say it again…there is no such thing as a quick fix! If there was there would be no diet industry. They don’t care about your health by creating these ridiculous things to help you lose weight. They are thinking about their bottom line. They don’t care what happens to you after you alter your body with their weight loss methods. They’d go out of business if there was a magic trick to make us fatties get skinny. Think about that.

Thank you again, Ragen, for another great post. This is truly a frightening device.

What I love about your blog is not only your consistent stand against any type of body shaming (shaming someone over how they look is so mean and horrible!), and your wonderfully named “underpants rule”, but also how you educate people about logical inconsistencies and poorly done research.

Those same tricks that are being used to convince people to believe in poorly done weight loss studies are also used to convince patients to believe in other poorly done medical research. You are teaching people how to use critical thinking and evaluate the science behind the claims. You’re helping people learn how to evaluate medical research rather than just accept whatever studies get published. That’s awesome!

I definitely agree that we should “… insist that the discussion be about actual health.”

OK, that’s NOT large. Not for a U.S. clinical trial. 1000 patients could be considered largish. Maybe.

“The most successful patients – those who aspirate regularly and learn to make healthier choices – have lost 100% of their excess weight with the AspireAssist and have maintained that weight loss for more than four years so far.”

1 – Tell us about it when they hit 5 years, please.

2 – Tell us HOW MANY “the most successful patients” are. Two? Three? That would just about fit in with the percentage of human beings who manage to maintain weight loss for five years. Which means, they would have done it, anyway, with, or without this device.

Also – any time you have a port in a human body, you are risking infection. Every time that port is used (three times a day?!) you are risking infection.

Ask anyone who has had to use a port on a regular basis, and has had recurring infections because of it, if it’s worth it. Well, if the port is to keep them ALIVE (say, for dialysis), then yeah, it’s worth it. If it’s just another attempt to make them thin (with what kind of actual percentage of thin-results? We aren’t really told) – worth it? I doubt it. We’re talking about lots of pain, lots of trips to the doctor and/or hospital, lots of antibiotics that work less and less as time goes on and the bacteria become more and more resistant. IT’s not a good thing.

Also, it sucks out 30% of the food you take in, but it can’t tell the difference between kale and ice cream. If you save your dessert for last, will it take it from the top of the stomach, or is it set in the bottom, to get those vitamin-rich vegetables you ate first? That lovely salad you ate, while waiting for the waiter to bring your entree? What about those who eat their sweets first or their veggies last?

And just speaking personally, if I know that I’m going to get rid of 30% of it, anyway, PLUS I have a high likelihood of throwing up the whole meal and/or getting diarrhea afterward, shucks, I’ll eat more, just to make sure it’s worthwhile. I mean, I really hate vomiting on an empty stomach, you know? Dry heaves are the worst. And if I’m going to go through the misery of vomiting or diarrhea, I’d much rather have such a sumptuous meal that I feel that pleasure counterbalances the misery. So, yeah, I’d be much MORE likely to engage in disordered eating if I get this thing than if I left my stomach alone, in the first place. I’m psychological like that.

I’m with you, I would almost definitely eat more if I knew I was about to pump a third of it out. Perhaps I’m a bit contrary by nature, but I get all kinds of obstinate when you start attempting to force me to do stuff for weight loss (or anything really-we dealt with infertility for years and the time I least wanted to have sex was when my calendar said I was probably ovulating).
The one and only 3 week period that I counted calories I ate more than usual simply because my doctor was recommending that I cut down to an 1800 calorie diet to “lose weight fast” to help my fibromyalgia. And when I decided counting calories was no longer necessary because I was eating an acceptable amount (not 1800 calories, but approx 2500) I think I ate even more for a few weeks.

You are like one voice in the darkness… I read everything you write (I get it in email). There is not one post, that I have not wondered “is she in my brain? Are we connected in these socially aberrant thoughts somehow?…” People are beginning to realize the gastric bypass is deadly, literally killing people, a wave of mass destruction, with decades of losses and stupidity. This seems like someone’s idea of a “less invasive” (more palatable and profitable) form of fat surgery. I live in Greenville, NC- the INVENTORS of the infamous “Greenville Gastric Bypass,” virtually the beginning of weight loss surgery in many ways. I researched this surgery over 20 yrs ago, it was unsound then, and is still unsound today (I still do my homework!). Yet, every visit to any doctor here I am inveritably asked have I considered a gastric bypass? No matter what doctor’s office I visit or what I am visiting for! I am so glad to read this, it is new information to me. My identical twin sister had a gastric bypass over 20 yrs ago- she died in Jan 2014 at age 57. Her life was forever burdened from complications from that surgery including first and foremost not being able to absorb any nutrition from her food! Not being able to absorb medicine, not being able to take medicine (would not fit in her stomach, was corrosive to her esophagus/stomach pouch, would not stay in her stomach from vomiting due to stomach/esophageal corrosion…), and so on. She was also brainwashed, in her last year I remember her saying in a phone call “not one item comes into this house that has fat in it, we buy no fat everything, our cheese slices contain no fat…” She did not realize, even being an RN, that she NEEDED fats to live. I have lived every day since her death a half life, without her my joy recedes, and experiences grow dull and meaningless. It is a cautionary tale I write here in my comment; beware, stand up against this bitter onslaught of fatism, have the strength to deny these false beliefs in the face of a society willing to kill us to satisfy their righteous indignation of anything/anyone fat.

The very idea this exists, that someone thought it was a good idea, makes me physically ill. I had a life threatening eating disorder when I was a teen, including years if bulimia. The only reason someone would want to engage in anything remotely resembling it is self loathing. That’s what needs addressed, not an imaginary failure to have the “right” kind of body. Oh, but so many industries would fail if people were actually taught to love themselves…can’t have that!

I have a friend who lost most of her digestive system due to a catastrophic combination of Crohn’s and freak blood clots. She survives on nutrition that goes directly into her bloodstream (though sometimes she eats for for enjoyment). The natural secretions and anything she takes by mouth have to be drained from her outlet-less stomach from the outside, necessitating a tube. It is larger that 6mm, mind you, but her sufferings from inflammation, caustic leakage, infections, and tube replacement are constant and intense.

That anyone thinks *choosing* this kind of malfunction, rather than using it to save a life in a rather extreme condition, is a good idea is pretty appalling.

I’m afraid they got the idea from someone just like your friend. That person was fat, but lost a little bit of weight, and who cares about the suffering that person underwent? They lost weight! Therefore, this must work!

What gets me is how did they ever convince 171 participants to participate? So much self-loathing in the world, brought about by the hatred others heap onto them, they have stopped defending themselves and turned the hatred inside, and now they’ll risk ANYTHING just to stop being hated.

I seem to be experiencing the nausea side effect just from reading about it… i’m sorry you had to read all about this horrible product to research this post!
I assume the company has just repurposed an existing piece of medical tech, normally used for cases as described by one of the other commenters.

OK, I read the thing and then I read the thing again. How can my body magically tell the difference between making myself throw up, and enduring a surgical procedure that implants a mechanism that turns me into a barfing cyborg? Is this like the special magic that lets my body tell the difference between dieting on purpose and not having enough food to satisfy my hunger?

As someone who has long been recovered from bulimia, I am beyond angry. I am heartbroken by the existence product.

I know I am taking it way too personally, but to me it almost feels like a mockery of my suffering…my worst nightmare turned into an FDA approved device to torture fat bodies. Of course dieting already did that, but it goes to show there are NO boundaries.

Everything everybody else said. And – how exactly does this help you keep weight off in the long run? If you’re eating the same amount, but no longer using the device to suck out 30% of it…hello? Won’t you eat what you did prior and return to the old weight?

Oh, wait. We weren’t looking to cure illness. We were looking to build a dependent customer base. Gaaaah

Please help me understand why someone would choose this instead of other weight loss options.
I really want to understand because I just can’t wrap my head around it.
If I thought that being fat was bad and I wanted to lose weight, I’d never choose this thing…
why would anyone?

At a guess, they are targeting people who experience hunger as bad conduct, and eating to satisfy hunger as a moral failing. Therefore, undoing the moral failing of eating a satisfying meal by losing a third of it may obviate the guilt.

To anybody out there who’s considering this, for whatever reason: It’s your body, your money, and your choice. But this is not your only option.

Probably because someone has tried all the other weight loss options. This smacks of “last resort.” And since science has proved, over and over, that dieting, exercise, and weight loss surgery do not work for long-term weight loss in 95% of human beings, “last resort” stuff happens.

In 1990, when I was 8, and I started dieting, I thought of something like this. I had spent my life before this puking from an undiagnosed ovarian cyst, so just taking the food out seemed like a good idea.

I had emergency surgery at age 11, and they thought it was appendicitis, as the pain was on the right side, but they opened me and saw a giant cyst, the size of a grapefruit, that had twisted over twice. For the previous 2 days I had not been able to keep anything down, and since I was 3 I had multiple puking episodes during my life. I think it was due to this malnutrition in childhood and dieting as a teenager is why I have anemia now, and 6-7 inches shorter than all the other women in my family, on both sides.

I think I was born with the cyst, as my earliest memories are of pain there. It was removed, along with the necrotising ovary and fallopian tube, so I only have 1 ovary left. Also my skin and muscles sag inwards on that side.

I think if something like that were to happen now, when I weigh 300 lbs and look every way the stereotypical “lazy fatty”, I would be sent home with WW, and I’d probably die from it.

so much this. If your blood pressure is just a few points too high, nope, we don’t need your life saving blood. Same if your iron is just .1 below 13 I think, or your pulse is slightly too fast… but wait come back, I’ve got this ridiculous device I’d like to cut a hole in your abdomen and put in.
I learned how to slow down my pulse just for giving blood, because mine was too fast the first time I tried, so the second time I went to do it I had been checking my pulse all day and watching the clock and taking deeper breaths when checking it and it would slow down.

oh, and I learned that if you convince the nurse to squeeze a little more blood out of your finger and check blood a little further in you have a better chance of your iron being in the acceptable range.

Off topic, I know but important: what they check at blood drives is hemoglobin, not iron. Sometimes a nurse or tech will tell someone with a low hemoglobin, “Your iron is low, ” and the patient will self medicate with iron supplements. Iron deficiency is one cause of low hemoglobin, but it must be diagnosed by more specific tests. Taking iron supplements when you are not iron deficient can lead to organ damage, because excess iron is not excreted. It builds up in organs and tissues, and can only be treated by lengthy, expensive chelation. I found this out the hard way. I have a rare blood disorder which causes a low hemoglobin with an extremely high iron level. When I was a broke college student, I was told my low hemoglobin was iron deficiency, and I should take supplements. Years later when I had enough insurance to be properly diagnosed, my iron level was sky high from the supplements, and I had to get subcutaneous infusions of chelating medication for over two years. I was lucky I didn’t kill my liver, pancreas or heart. Blood drive people should not try to dumb down their information by calling low hemoglobin “low iron.” They can’t tell that from a hemoglobin check. And NO ONE should take iron supplements unless they are diagnosed iron deficient. Iron supplements can be toxic. IMHO, they shouldn’t be available OTC.